|
HCHG CARCINOEMBRYONIC AG, BODY FLUID
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
H3011554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: AlohaCare Medicaid |
$18.96
|
| Rate for Payer: AlohaCare Medicare |
$18.96
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$20.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.96
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Humana Medicare |
$18.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.96
|
| Rate for Payer: MDX Hawaii PPO |
$186.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.96
|
| Rate for Payer: University Health Alliance Commercial |
$49.04
|
|
|
HCHG CARDIAC CTA W WO DISEASE STRXR
|
Facility
|
OP
|
$1,508.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
H3500217
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$137.95 |
| Max. Negotiated Rate |
$1,462.76 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$980.20
|
| Rate for Payer: Cash Price |
$980.20
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$137.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$222.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,281.80
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$950.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$769.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$1,462.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$773.32
|
|
|
HCHG CARDIAC CTA W WO DISEASE STRXR
|
Facility
|
IP
|
$1,508.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
H3500217
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,281.80 |
| Max. Negotiated Rate |
$1,462.76 |
| Rate for Payer: Cash Price |
$980.20
|
| Rate for Payer: Health Management Network Commercial |
$1,281.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,462.76
|
|
|
HCHG CARDIAC RISK/LIPID PROFILE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
H3010320
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: AlohaCare Medicaid |
$13.39
|
| Rate for Payer: AlohaCare Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Devoted Health Medicare |
$14.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.39
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Humana Medicare |
$13.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.39
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.39
|
| Rate for Payer: University Health Alliance Commercial |
$34.63
|
|
|
HCHG CARDIAC RISK/LIPID PROFILE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
H3010320
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
|
|
HCHG CARDIOLIPIN IGA AB
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$25.45
|
| Rate for Payer: AlohaCare Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Devoted Health Medicare |
$28.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.45
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$25.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.45
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.45
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
HCHG CARDIOLIPIN IGA AB
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
HCHG CARDIOLIPIN IGG AB
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
HCHG CARDIOLIPIN IGG AB
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$25.45
|
| Rate for Payer: AlohaCare Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Devoted Health Medicare |
$28.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.45
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$25.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.45
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.45
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
HCHG CARDIOLIPIN IGM AB
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$25.45
|
| Rate for Payer: AlohaCare Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Devoted Health Medicare |
$28.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.45
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$25.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.45
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.45
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
HCHG CARDIOLIPIN IGM AB
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
HCHG CARDIOVERSION
|
Facility
|
IP
|
$3,306.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
H4500158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,810.10 |
| Max. Negotiated Rate |
$3,206.82 |
| Rate for Payer: Cash Price |
$2,148.90
|
| Rate for Payer: Health Management Network Commercial |
$2,810.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,206.82
|
|
|
HCHG CARDIOVERSION
|
Facility
|
OP
|
$3,306.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
H4500158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$780.80
|
| Rate for Payer: AlohaCare Medicare |
$780.80
|
| Rate for Payer: Cash Price |
$2,148.90
|
| Rate for Payer: Cash Price |
$2,148.90
|
| Rate for Payer: Cash Price |
$2,148.90
|
| Rate for Payer: Devoted Health Medicare |
$858.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$780.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,140.70
|
| Rate for Payer: Health Management Network Commercial |
$2,810.10
|
| Rate for Payer: Humana Medicare |
$780.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,082.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$780.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,206.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$858.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$780.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$780.80
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CARDIOVERSION EXTERNAL
|
Facility
|
IP
|
$2,613.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
H4800110
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,221.05 |
| Max. Negotiated Rate |
$2,534.61 |
| Rate for Payer: Cash Price |
$1,698.45
|
| Rate for Payer: Health Management Network Commercial |
$2,221.05
|
| Rate for Payer: MDX Hawaii PPO |
$2,534.61
|
|
|
HCHG CARDIOVERSION EXTERNAL
|
Facility
|
OP
|
$2,613.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
H4800110
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$780.80
|
| Rate for Payer: AlohaCare Medicare |
$780.80
|
| Rate for Payer: Cash Price |
$1,698.45
|
| Rate for Payer: Cash Price |
$1,698.45
|
| Rate for Payer: Cash Price |
$1,698.45
|
| Rate for Payer: Devoted Health Medicare |
$858.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$780.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,482.35
|
| Rate for Payer: Health Management Network Commercial |
$2,221.05
|
| Rate for Payer: Humana Medicare |
$780.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,646.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,332.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$780.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,534.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$858.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$780.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$780.80
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CAREGIVER HEALTH RISK ASSMT
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
H4501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
|
|
HCHG CAREGIVER HEALTH RISK ASSMT
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
H4501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$44.26
|
| Rate for Payer: AlohaCare Medicare |
$44.26
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Devoted Health Medicare |
$48.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.80
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Humana Medicare |
$44.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.26
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.26
|
| Rate for Payer: University Health Alliance Commercial |
$90.38
|
|
|
HCHG CARNITINE FREE & TOTAL QUANT
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
H3010322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$16.87
|
| Rate for Payer: AlohaCare Medicare |
$16.87
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Devoted Health Medicare |
$18.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.87
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$16.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.87
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.87
|
| Rate for Payer: University Health Alliance Commercial |
$43.60
|
|
|
HCHG CARNITINE FREE & TOTAL QUANT
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
H3010322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
HCHG CAROTID DPLX SCAN, BILAT STUDY
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
H9210106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CAROTID DPLX SCAN, BILAT STUDY
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
H9210106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$734.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CAROTID DPLX SCAN-UNILAT
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
H9210108
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$712.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
|
|
HCHG CAROTID DPLX SCAN-UNILAT
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
H9210108
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$89.14 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$796.10
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$527.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$427.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$610.82
|
|
|
HCHG CARS/BD TST INFT-12MO +30MIN
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
H4120104
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HCHG CARS/BD TST INFT-12MO +30MIN
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 94781
|
| Hospital Charge Code |
H4120104
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.50
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.03
|
| Rate for Payer: University Health Alliance Commercial |
$109.33
|
|
